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Long Term Rental Application

Rental Application Form

Please fill in the form below. All fields marked * are required.

Every occupant over the age of 18 MUST fill out a seperate application (even if married).

Note: all submitted information is confidential and will soley be used in regards to reviewing the application by our staff.

Personal Information

First Name*

Middle

Last*

S.S.#*

Date of Birth*

Marital Status*
SingleMarriedDivorced

Drivers License #*

Drivers License State*

Primary Phone #*

Secondary Phone #

Email Address*

Present Home Address*

City/State/Zip*

Length of Time*

Reason for Leaving*

Present Landlord*

Landlord Phone #*

Amount of Rent*

Is your present rent up to date?*
YesNo

Previous Home Address

City/State/Zip

Length of Time

Reason for Leaving

Previous Landlord

Landlord Phone #

Amount of Rent

Was your rent up to date?

Will anyone be living with you?*
YesNo

Do you have a pet(s)?*
YesNo

Do you own a vehicle(s)?*
YesNo

Are you employed?*
YesNo

Proposed Occupant(s)

Name*

Relationship*

Occupation*

Age*

Name

Relationship

Occupation

Age

Name

Relationship

Occupation

Age

Name

Relationship

Occupation

Age

Proposed Pet(s)

Name

Type/Breed

Weight

Age

Name

Type/Breed

Weight

Age

Vehicle(s) Information

Make/Model/Year

Color

Plate #

State

Make/Model/Year

Color

Plate #

State

Employment & Income

Current Employer*

Occupation*

Hours/Week*

Supervisor*

Phone #*

Years Employed*

Address*

City/State/Zip*

Current Income $*

WeeklyBimonthlyMonthlyYearly

Proof of Income*
YesNo

Enter the code shown above

* Required

Galveston Vacation Home Rentals

GCC Real Estate Broker:

Gulf Coast Concierge

1-888-977-WAVE(9283)
409-744-5716
Email Reservations@gulfcoastconcierge.com
8910 Seawall Blvd. Suite C
Galveston,TX 77554
Website Map

GCC Real Estate Broker:

Gulf Coast Concierge

1-888-977-WAVE(9283)
409-744-5716
Email Reservations@gulfcoastconcierge.com
8910 Seawall Blvd. Suite C
Galveston,TX 77554
Website Map

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